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_o 1y Ali OPERATING PERMIT APPLICATION-TANK INFORMATION(One form pm UST) KERN COUNTY EVVI R.ONMENTAL HEALTH SERVICES UNIFIED PROGRAM CONSOLIDATED FORM DEPARTMENT UNDERGROUND STORAGE TANK 2700 M STREET,SUITE 300 BAKERSFIELD,CA 93301 (661)862-8700 Fax(661)862-8701 (one page per tank) Page-L-of 9 TYPE OF ACTION ((:heck als Nun only. For w UST permawt elm=a removaL complete only this section and Sectimss L It,BI,IV,WA Ix below) ^� ® 1.NEW PERMIT ❑ 3.RENEWAL PERMR ❑ 5L CHANOE OF INFORMATION 6.TEMPORARY UST CLOSURE ❑ 7-USTPERMANENT CLOSURE ON SITE ❑ 8.UST REMOVAL DATE UST PERMANENTLY CLOSED: aM10' DATE EXISTINGUSTDISCOVERED: 410 L FACILITY INFORMATION FACILITYID#(Agency Um 0*) _ 1 BUSINESS NAME(Same as FACILITY NAME a DBA-Doing Busims AS) � 3 Love's Travel Stop#538 BUSINESS SITE ADDRESS iN CrrY ra BUSINESS SITE AD Road I D:TANK DESCRIPTION TANKIDN 3 432 TANK MANUFACTURER 433 TANKCONFIGURATION:TILS TANK f5 434 X=w [3 1.ASrANr ALONE TANK -FAV5 02.ONE W A COMPARTMENTED Wit. DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 06 NUMBER OF COMPARTMENTS IN THE UNIT' 4)7 9(1013 8000 2 III,TANK USE AND CONTENTS TANK USE 1@ la MOTOR VEHICLE RIELING ❑ IL.MARINA FUELING ❑ t0.AVIATION FUELING 439 ❑ 3.CHEMICAL PRODUCT STORAGE Q 4.IAZAROCNS WASTE(�U+ OO) Q S.EMERGENCY GFNFRATOR FUEL[1 s 62m1.5(4)l ❑ 6.07TIERGENEBATORFUE. ❑ ".UNKNOWN Q 99.OTHER (SP-ify): 439E CONTENTS PETROLEUM: ❑ Is.REGULAR UNLEADED ❑ 1e MRIGRADE UNLEADED ® Ib.PRENUUM UNLEADED 440 ❑3-DIESEL ❑ 5.JETx1EL Q 6.AVIATION GAS Q 8_PETROLEUM BLEND FUEL ❑ 9.0THFRPETROLEUM 41W NOMPEIROLaw,❑7,USmOIL ❑ 10.ETHANOL Q 11.OTHER NON-PETROLEUM 4406 IV. TANK CONSTRUCTION TYPEOFTANK ❑ ITSINGLEWALL ® LDOUBLE WALL Q 95,11NKNOWN PRIMARY OONTAINMENT LI 1.STEL 3.FIBERGLASS ❑ 6.INTERNAL BLADDER 4M ❑ 7.STEEL+INTERNAL LINING ❑ 93.UNKNOWN ❑ 99.OTHER k 444. SECONDARYCONTAINWGWT ❑ 1.STEEL ®3.FIBERGLASS Q 6ER .EXTIOR WDORANE LINER ❑ 7.IAOCEIFD MS ❑90.NONE Q 95,UNKNOWN ❑99.OTHERi , HL OVERFILLPREVETION ® I.AUDIBLE k VISUAL ALARMS ❑ 2.BALLFLOAT N 3.FILL TUBE SHUT-OFF VALVE 452 ❑ 4 TANK MEETS REQUIRHNEIITS FOR O E4 WM FROM OVERFILL PREVDMON V. PRODUCT/WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION ❑1.SO4GLE-WALLED N 2 DOUBLCWALLED ❑99.OTHER 4m SYSTEM TYPE Iffl LPRPSSURE ❑T.GRAVITY 3.COHVEN170NALSUCIWN 04.SAFE SUCTION V3CIX M 6(. 3)145e PRIMARY CONTAOIMENT ❑ L STEEL W 4.FIBERGLASS ❑ B.flEXIBLE ❑ 10.RIGID PLASTIC 464 Q 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHERSphcify): 464. SECONDARY CONTAMMENT ❑ I.STEEL ® 4,FMERGLASS ❑ 8.FIEMLE ❑ IB.RIGID PLASTIC 4ub ❑ 90.NONE ❑ 95.UNKNOWN ❑ 99.OTHER(Spoify): 46ao I'MMOnURBINE CONTAINMENT SUMP TYPE Q I.SINGLE WALL N 2.DOUBLE WAIL 0 90.NONE f61d VL VENT,VAPOR RECOVERY(VR)AND RISER/FILL PIPE PIPING CONSTRUCTION VENT PRIMARY CONTABudENT L1 I.STEEL 0 4.FIBERGLASS 0 MRIGDPfASTIC 0 90.NONE 0 99.OTHER(Spoify) 1644 46b1 VENT SECONDARY CONTAINMENT ❑ I.STEEL 19 4-.FIBERGLASS ❑ IO.RICIDPVSTIC ❑ 90.NONE ❑ 99-017IDt(SPedfy) 46v 46 VR PRIMARY CONTA)NA4NT ❑ I.STEEL 0 4.FlBERGIASS 0 70.RIGID PLASTIC 13 90.NONE 11 99.OI1fER(Speedy) 4648 VR SECONDARY CONTARR4ENT 0 1.STEEL ® LFIBFRGIASS 0 IO.RLGIURJSIiC ❑ 90.NONE 99-OTHER(Spedfy) 464h 6W VENTPIPINOTRAN51770N SI, 112.13DUBLE WALL 0 90,NONE 461E RISER PRIMARY CONTAINN[ENT ® I.STEEL Q 4.FIBERGLASS ❑ 10.RIGID PLASTIC U W NONE U 99.OTHER(Bpccwy) 462 4641 RISER SECONDARY CONTADAMFNT 1.STEEL 0 4.FIRFRGLASS ❑ 10.RIGID PLASTIC ® 90.NONE 99.OTNER(SWofy) 46H LI FILL(bhffOHEFfrS INSTALLED I.SPBLLBUCKET 01STFUICERFLATEW770MMOTECTOR 04,CONTARMEENT4UMP 431w VII.UNDER DISPENSER CONTAINMENT(UDC) CONSTRUCTION TYPE ❑ L SINGLE WAIL ® 3.DOABLE WALL Q 3.NO DISPENSERS Q 90,NOHIK-kms 469. CONSIBUCT10N MATERIAL Q I,STEEL ® 4.FIBERGLASS 0 10.RIGID PLASHC Q 99,OTHER a696< VIII. CORROSION PROTECTION STETS COMPONENT PROTECTION ❑ 2.SACRIFICIAL ANODE(S) Q 4.9APRESSFE)CURRENT ® 6.ISOLATION D(- APPLICANT SIGNATURE CERTIFICATION:I certify that this UST System is mmpstible with the hazardous substance shred and that We information provided herein e,eccuwl4 W In full was INOU with WRO requircumenun, APPLICANT SIGNATURE DATE 7/29/2013 470. a� APPLICANT NAME(print) PQrnbedyMilly APPLICANT TITLE West Coast Environmental er 472 UPCF UST-8-in Rev,(1210(17)